Publications


Reproductive Health Outcomes & Contraceptive Use among U.S. Teens Print

Also available in [PDF] format.

Many U.S. teens do not use contraception and condoms consistently. As a result, each year many teens experience pregnancy, mostly unintended. Yet about half of all pregnancies among U.S. women each year are unintended. In fact, teens’ use of contraception and condoms mirrors that of adult women and men.

Pregnancy Rates in the United States Have Declined But Remain High

  • In 2004, teens accounted for about 11 percent of all the pregnancies among U.S. women, about 10 percent of the births, and just under 7 percent of the abortions.[1,2,3]
  • In the United States in 2004, there were 72.2 pregnancies per 1,000 women ages 15 through 19, including 1.6 per 1,000 teens under age 15; 41.5 per 1,000 teens ages 15 through 17; and 118.6 per 1,000 teens ages 18 and 19.[1]
  • Pregnancy rates in 2004 were higher among adult women than among teens. For example, there were 164 pregnancies per 1,000 women ages 20 through 24; 169 per 1,000 women ages 25 through 29; and 135 per 1,000 women ages 30 through 34.[1]
  • Between 1990 and 2004, U.S. adolescent pregnancy rates declined 38 percent among 15- to 19-year-old women; 53 percent among youth under age 15; 46 percent among 15- to 17-year-olds; and 30 percent among 18- to 19-year-olds.[1]
  • Teen pregnancy rates dropped in three major ethnic groups in 2004; yet pregnancy rates remained higher for black and Hispanic teens than for whites. Among teens ages 15 through 19, the pregnancy rate was 45 per 1,000 non-Hispanic whites; 128 per 1,000 non-Hispanic blacks; and 133 per 1,000 Hispanics.[1]

U.S. Birth Rates Rise

  • In 2006, American women gave birth to 4,265,996 infants, the largest number of births since 1961. Women ages 15 through 19 had about 10 percent (435,427) of the births, while women in their 20s had about 53 percent of the infants.[2]
  • Birth rates for U.S. teens ages 15 through 19 rose three percent, from 40.5 in 2005 to 41.9 per 1,000 in 2006, the first increase reported since 1991. At the same time, birth rates also rose among all age groups of adult women.[2]
  • Among U.S. teens ages 15 through 19, the birth rate was lowest among Asian and Pacific Islanders at 17 per 1,000. The birth rates were: 27 per 1,000 non-Hispanic whites; 55 per 1,000 American Indian/Alaska natives; 64 per 1,000 non-Hispanic blacks; and 83 per 1,000 Hispanics.[2]

Fewer Young Women Seek Abortions

  • Pregnancies among women ages 15 through 19 are more than twice as likely to end in live birth as in abortion.[1]
  • The proportion of abortions obtained by women younger than 20 has dropped steadily since 1974. In that year women younger than 20 accounted for 33 percent of all abortions; in 1989, 25 percent, and in 2004, only 17 percent.[3]
  • The number of abortions in the United States declined by 24 percent between 1990 and 2004, down from 1.61 million to 1.22 million. In 2004, the abortion rate was 19.7 per 1,000 women ages 15 through 44,[2,4] and 19.8 per 1,000 women ages 15 through 19.[4,5]
  • In 2004, the abortion rate was 11 per 1,000 non-Hispanic whites ages 15 through 19, down from 33 per 1,000 in 1990. Among Hispanic teens, the rate in 2004 was 27, down from 39 in 1990. For non-Hispanic black teens, the 2004 rate was 47, down from 84 in 1990.[1
  • Between 1990 and 2004, the abortion rate fell by two-thirds among non-Hispanic white teens, by almost a third among Hispanic teens, and by 44 percent among non-Hispanic black teens.[1]

Young People Experience the Greatest Proportion of Unintended Pregnancies

  • While about half of all pregnancies in the United States are unintended, rates of unintended pregnancy are highest among women ages 18 and 19 and 20 through 24.[6]
  • The proportion of unintended pregnancies remains highest among women under age 20. In other words, about 85 percent of teenage pregnancies are unintended compared to about 50 percent among adult women.[6]
  • Unintended pregnancy rates are about four times higher among women whose income is at or below the federal poverty line (112 per 1,000 women) than among women whose income is at least twice the federal poverty level (29 per 1,000).[6]

Contraceptive Use and Inconsistent Use Are Problematic Among American Women

  • Half of all unintended pregnancies occur among contraceptive users; 90 percent result from inconsistent or incorrect method use.[7]
  • By comparison, half of all unintended pregnancies occur among the relatively small percentage of women who use no contraception. For example, half of all unintended pregnancies among sexually active high school students occurs among the 88 percent who use contraception (even if inconsistently or incorrectly) and half occurs among the 12 percent who report using no method.[8,9]
  • Studies show that women with ambivalent attitudes toward pregnancy use contraceptives less consistently and less effectively than women who have clear, firm motivation to avoid pregnancy.[8]
  • In 2003, among sexually active high school students who reported using contraception: 14 percent used oral contraceptives; 49 percent used condoms only; six percent used both oral contraceptives and condoms; 11 percent relied on withdrawal; three percent on injected contraception; two percent on both condoms and injected contraception; two percent used an undefined method; and less than half of one percent used an undefined method and condoms. Twelve percent used no method.[9]
  • Research shows that males who reported engaging with their partner in more couple-like activities were more likely to have ever used and always used contraception as were females who had discussed contraception before sex.[10]
  • Research suggests that many teens make decisions about whether to use contraception and/or condoms within the context of each sexual relationship. While some studies indicate more consistent use in casual relationships than in regular or main relationships, other studies indicate that, the less familiar adolescents felt with a prospective partner, the less likely they were to use contraception, possibly because they felt less comfortable discussing sex, sexual histories, and contraception.[10]
  • Research also shows that male teens who did not use contraception during a first sexual relationship were 66 percent less likely to have used contraception in their latest relationship compared to males who used contraception at first sex.[9] Males who suffered sexual abuse in the past were far less likely to use contraception than males who never suffered such abuse.[8]
  • Female teens who did not use contraception during a first sexual relationship were less likely to have used it in their latest relationship. Females were also unlikely to use contraception if their partner was initially a stranger to them. And, females’ likelihood of using contraception was reduced by 20 percent for each additional partner they had ever had.[10]
Written by Sue Alford, MLS
© 2008 Advocates for Youth

References:
  1. Ventura SJ et al. Estimated pregnancy rates by outcome for the United States, 1990-2004. National Vital Statistics Reports 2008; 56(15):1-24; http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_15.pdf; accessed 7/23/2008.
  2. Hamilton BE et al. Births: preliminary data for 2006. National Vital Statistics Reports 2007; 56(7):1-18; http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_07.pdf; accessed 7/24/2008.
  3. Henshaw SK and Kost K. Trends in the Characteristics of Women Obtaining Abortions, 1974-2004. New York: Guttmacher Institute, 2008.
  4. Strauss LT et al. Abortion surveillance, United States, 2004. Morbidity & Mortality Weekly Report, Surveillance Summaries 2007; 56(SS09):1-33.
  5. Jones RK et al. Abortion in the United States: incidence and access to services, 2005. Perspectives on Sexual & Reproductive Health 2008; 40(1):6-16.
  6. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual & Reproductive Health 2006; 38(2):90-96.
  7. Frost JJ, Darroch JE. Factors associated with contraceptive choice and inconsistent method use, United States, 2004. Perspectives on Sexual & Reproductive Health 2008; 40(2):94-104.
  8. Frost JJ et al. Factors associated with contraceptive use and nonuse, United States, 2004. Perspectives on Sexual & Reproductive Health 2007; 39(2):90-99.
  9. Santelli JS et al. Contraceptive use and pregnancy risk among U.S. high school students, 1991-2003. Perspectives on Sexual & Reproductive Health 2006; 38(2):106-111.
  10. Manlove J et al. Contraceptive use and consistency in U.S. teenagers' most recent sexual relationships. Perspectives on Sexual & Reproductive Health 2004; 36(6): 265-275.
This publication is part of The Facts series.
 
Adolescent Pregnancy and Protective Behaviors Print
Also available in [PDF] format.

Until recently, adolescent pregnancy and birth rates in the United States had been slowly but steadily declining. But 2006 data showed a three percent rise in birth rates among 15- to 19-year-old women.1 Recent research also provides evidence of adolescents’ protective behaviors, both abstinence and contraceptive use. This paper describes recent trends in pregnancy, birth, and abortion rates, and offers findings on abstinence and contraceptive use among teens.

Pregnancies and Pregnancy Rates in the United States

  • In 2004, teens accounted for about 11 percent of all the pregnancies among U.S. women, about 10 percent of the births, and just under 10 percent of the abortions.[1,2,3]
  • In the United States in 2004, there were 72.2 pregnancies per 1,000 women ages 15 through 19, including 1.6 per 1,000 teens under age 15; 41.5 per 1,000 teens ages 15 through 17; and 118.6 per 1,000 teens ages 18 and 19.2
  • Pregnancy rates in 2004 were higher among adult women than teens. For example, there were 164 pregnancies per 1,000 women ages 20 through 24; 169 per 1,000 women ages 25 through 29; and 135 per 1,000 women ages 30 through 34.[2]
  • Between 1990 and 2004, U.S. adolescent pregnancy rates declined 38 percent among 15- to 19-year-old women; 53 percent among youth under age 15; 46 percent among 15- to 17-year-olds; and 30 percent among 18- to 19-year-olds.[2]
  • Teen pregnancy rates dropped in three major ethnic groups yet remained higher for black and Hispanic teens than for whites. In 2004, among teens ages 15 through 19, the pregnancy rate was: 45 per 1,000 non-Hispanic whites; 128 per 1,000 non-Hispanic blacks; and 133 per 1,000 Hispanics.[2]
  • In one study, bisexual and lesbian teens, although about equally likely to have had sex as their heterosexual peers, had more than twice the proportion of pregnancies (12 versus five percent, respectively).[4]

U.S. Births and Birth Rates

  • In 2006, American women gave birth to 4,265,996 infants, the largest number of births since 1961. Women ages 15 through 19 accounted for about 10 percent (435,427) of the births, while women in their 20s had about 53 percent of the infants.[1]
  • Birth rates for U.S. teens ages 15 through 19 rose three percent, from 40.5 in 2005 to 41.9 per 1,000 in 2006, the first increase reported since 1991. At the same time, birth rates also rose among all age groups of adult women.[1]
  • Among U.S. teens ages 15 through 19, the birth rate was lowest among Asian and Pacific Islanders at 17 per 1,000. The rates were: 27 per 1,000 non-Hispanic whites; 55 per 1,000 American Indian/Alaska natives; 64 per 1,000 non-Hispanic blacks; and 83 per 1,000 Hispanics.[1]

Abortion in the United States

  • Pregnancies among women ages 15 through 19 are more than twice as likely to end in live birth as in abortion.[2]
  • The proportion of abortions obtained by women younger than 20 has dropped steadily since 1974. In that year women younger than 20 accounted for 33 percent of all abortions; in 1989, 25 percent, and in 2004, only 17 percent.[5]
  • The number of abortions in the United States declined by 24 percent between 1990 and 2004, down from 1.61 million to 1.22 million. In 2004, the abortion rate was 19.7 per 1,000 women ages 15 through 44 and 19.8 per 1,000 teens ages 15 through 19.[3,6]
  • Among white, black, and Hispanic teens, abortion rates fell but remained lowest for white teens. In 2004, the rate was 11 per 1,000 non-Hispanic whites ages 15 through 19, down from 33 per 1,000 in 1990. Among Hispanic teens, the rate in 2004 was 27 per 1,000, down from 39 in 1990. For non-Hispanic black teens, the 2004 rate was 47 per 1,000, down from 84 in 1990.[2]
  • As the 1990 and 2004 rates show, the abortion rate fell by two-thirds among non-Hispanic white teens, by almost a third among Hispanic teens, and by 44 percent among non-Hispanic black teens.[2]

Unintended Pregnancy

  • While about half of all pregnancies in the United States are unintended, rates of unintended pregnancy are highest among women ages 18 and 19 and 20 through 24.[7]
  • The proportion of unintended pregnancies remains highest among women under age 20. In other words, about 85 percent of teenage pregnancies are unintended compared to 50 percent  of pregnancies among adult women.[7]
  • Unintended pregnancy rates are about four times higher among women whose income is at or below the federal poverty line (112 per 1,000 women) than among women whose income is at least twice the federal poverty level (29 per 1,000).[7]

U.S. Teens Report Delaying Sex Longer than in the Past

  • In 2007, 52 percent of all U.S. high school students reported never having had sexual intercourse. The proportions who never had sex decreased as teens grew older. For example, 67 percent of students in ninth grade reported never having had sex compared to 35 percent of students in twelfth grade.[8]
  • Abstinence rates increased between 1991 and 2007 by gender and by race/ethnicity. In 1991, 49 percent of teen females in high school said they had never had sex, compared to 54 percent in 2007. Among males, the numbers were 43 and 50 percent, respectively.[8,9]
  • Fifty percent of white students said they never had sex in 1991, compared to 56 percent in 2007. Among Hispanic students, the numbers were 47 and 48 percent, respectively; and among blacks, 19 and 34 percent, respectively.[8,9]
  • In one study, only 14 percent of gay, lesbian, and bisexual high school students had never had sex, compared to 52 percent of their heterosexual peers.[10]

U.S. Teens Initiate Sex Later than Peers in Some Countries but Do Not Use Contraception as Well

  • In the United States, the typical age at first sexual intercourse is 17.5 [13] compared to 16.7 in Great Britain, 16.4 in the Netherlands, and 17.1 in France.[14]
  • Although U.S. teens report using contraception and/or condoms far more often than their peers of previous decades, they still use contraception or condoms less consistently than their peers in Europe. For example, 14 percent of sexually experienced U.S. female teens recently reported using oral contraceptives at most recent sex, compared to 26 percent of French, 55 percent of German, and 61 percent of Dutch teens. Among sexually experienced males, 73 percent of U.S. teens reported condom use at most recent sex compared to 88 percent of French, 83 percent of German, and 85 percent of Dutch teens.[8,15]
  • A study on the effect of virginity pledges found that, in early and middle adolescence, pledging delayed the transition to first sex by as much as 18 months. Pledging only worked when not more than about one-third of students pledged. Moreover, when they broke the pledge, these teens were one-third less likely to use contraception at first sex than were their non-pledging peers.[11] Said the lead researcher, "If we consider the enhanced risk of failure to contraception against the benefit of delay, it turns out that with respect to pregnancy, pledgers are at the same risk as non-pledgers. There is no long-term benefit to pledging in terms of pregnancy reduction, unless pledgers use contraception at first intercourse."[12]

Sexually Active Teens' Use of Condoms Is Up but Leveling Off

  • In U.S. studies, 70 percent of women and 69 percent of men ages 15 to 19 reported condom use at first sex.[16]
  • Among sexually active U.S. high school youth in 2007, 62 percent reported using a condom during most recent sex—a significant increase over 46 percent in 1991, but less than the 63 percent so reporting in 2005.8,9
  • In 2007, black sexually active high school students were more likely than their Hispanic or white peers to report condom use (67, 61, and 60 percent, respectively).[8]
  • In one study, fewer gay, lesbian, and bisexual high school students reported condom use at most recent sex than their heterosexual peers (51 and 58 percent, respectively).[10]

Sexually Active Youth Need Support to Use Contraception Consistently and Correctly

  • Among sexually active high school students who reported using contraception in 2003: 14 percent used oral contraceptives; 49 percent used condoms only; six percent used both oral contraceptives and condoms; 11 percent relied on withdrawal; three percent, on injected contraception; two percent, on both condoms and injected contraception; two percent used an undefined method; and less than half of one percent used an undefined method and condoms. Twelve percent used no method.[17]
  • Experts say that half of all unintended pregnancies occur among contraceptive users and that 90 percent of these pregnancies result from inconsistent or incorrect use of a method rather than from method failure.[18]
  • By comparison, half of all unintended pregnancies occur among the relatively small percentage of women who use no contraception. For example, half of all unintended pregnancies among sexually active high school students occurs among the 88 percent who report using contraceptives (even if inconsistently or incorrectly) and half occurs among the 12 percent who report using no method.[17,18]
  • Studies show that women with ambivalent attitudes toward pregnancy use contraceptives less consistently and less effectively than women who have clear, firm motivation to avoid pregnancy.[19] For example in one study, inconsistent use of condoms was most common among women who felt that avoiding pregnancy was only a little important or not important compared to those who thought it was very important (77 versus 55 percent).[18]
  • Another study found that women who switched methods were at higher risk of unintended pregnancy than were women who used the same method over time, mostly due to difficulty adjusting to a new method or restarting after a period of nonuse.[19]
  • Research shows that male and female teens’ contraceptive use in their first sexual relationship was significantly associated with contraceptive use in later relationships. Conversely, males who did not use contraception during a first sexual relationship were 66 percent less likely than other males to use contraception in their current relationship. Females who did not use contraception at first sex were also less likely than other females to use contraception in later relationships.[20]
  • Males who reported engaging with their partner in more couple-like activities were almost twice as likely to have ever used and always used contraception. For females, having discussed contraception before sex was also associated with increased odds of having ever used and consistently used contraception in later relationships.[20]
  • Research suggests that many teens make decisions about whether to use contraception and/or condoms within the context of each sexual relationship. While some studies indicate more consistent use in casual relationships than in regular or main relationships, other studies indicate that, the less familiar adolescents felt with a prospective partner, the less likely they were to use contraception, possibly because they felt less comfortable discussing sex, sexual histories, and contraception.[20
  • For females, if a partner was initially a stranger to her, she was less likely to use contraception than if he had been previously known to her.20 In addition, females’ likelihood of using contraception was reduced by 20 percent for each additional partner they had ever had.[20]
  • Research also shows that males who suffered sexual abuse in the past were far less likely to use contraception than males who never suffered such abuse.[19]

Pressure, Lack of Knowledge, and Worries about Confidentiality Affect Teens’ Use of Contraception

  • In one study, eight percent of sexually experienced young women cited pressure from their partner as a factor in having sex for the first time. Seven percent cited pressure from their friends. Among young men, the percentages were one and 13 percent, respectively.[21]
  • When polled, 32 percent of U.S. teens believed condoms were not effective in preventing HIV; 22 percent believed that birth control pills were not effective in preventing pregnancy. In addition, 66 percent said they would feel suspicious or worried about their partner's past, if he/she suggested using a condom and 49 percent would worry that the partner was suspicious of them; 20 percent would feel insulted.[22]
  • In another study, 83 percent of sexually active women under age 18 indicated that mandatory parental notification would cause them to stop using some or all confidential sexual health services; 57 percent said they would stop using hormonal contraception and use condoms instead; 29 percent said they would have unprotected sex. Only one percent would stop having sex.[23]
  • Studies have shown that homophobia and violence are significant barriers to protective behaviors among lesbian, gay, bisexual, and transgender youth. These stressors damage youth’s self-esteem and may result in homelessness and a need to exchanged sex for shelter, food, and/or safety.[24]
Written by Sue Alford, MLS
© 2008 Advocates for Youth

References:
  1. Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2006. National Vital Statistics Reports 2007; 56(7):1-18; http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_07.pdf; accessed 7/24/2008.
  2. Ventura SJ, Abma JC, Mosher WD et al. Estimated pregnancy rates by outcome for the United States, 1990-2004. National Vital Statistics Reports 2008; 56(15):1-24; http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_15.pdf; accessed 7/23/2008.
  3. Strauss LT, Gamble SB, Parker WY et al. Abortion surveillance, United States, 2004. Morbidity & Mortality Weekly Report, Surveillance Summaries 2007; 56(SS-9):1-33.
  4. Saewyc EM, Magee LL, Pettingell SE. Sexual intercourse, abuse and pregnancy among adolescent women: does sexual orientation make a difference? Family Planning Perspectives 1999; 31:127-31.
  5. Henshaw SK and Kost K. Trends in the Characteristics of Women Obtaining Abortions, 1974-2004. New York: Guttmacher Institute, 2008.
  6. Jones RK, Zolna MRS, Henshaw SK et al. Abortion in the United States: incidence and access to services, 2005. Perspectives on Sexual & Reproductive Health 2008; 40:6-16.
  7. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual & Reproductive Health 2006; 38:90-96.
  8. Eaton DK, Kann L, Kinchen S et al. Youth risk behavior surveillance, United States, 2007. Morbidity & Mortality Weekly Report 2008; 57(SS-4):1-138; http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf; accessed 6/11/2008.
  9. Eaton DK, Kann L, Kinchen S et al. Youth risk behavior surveillance, United States, 2005. Morbidity & Mortality Weekly Report 2006; 55(SS-5):1–108.
  10. Blake SM, Ledsky R, Lehman T et al. Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: the benefits of gay-sensitive HIV instruction in schools. American Journal of Public Health 2001; 91:940-46.
  11. Bearman PS, Brückner H. Promising the Future: Virginity Pledges as They Affect Transition to First Intercourse. New York: Columbia University, 2000.
  12. Bearman P. [Letter; quoted with permission]. New York: Columbia University, 2002.
  13. Guttmacher Institute. Facts on Young Men’s Sexual & Reproductive Health [In Brief] New York: Author, 2008; http://www.guttmacher.org/pubs/fb_YMSRH.pdf; accessed 8/7/2008.
  14. IPPF European Network, the SAFE Project. Sexuality Education in Europe. Brussels, Belgium: Author, 2006; http://www.euro.who.int/Document/RHP/SexEd_in_Europe.pdf; accessed 7/7/2008.
  15. Godeau EC, Gabhainn SN, Vignes C et al. Contraceptive use by 15-year-old-students at their last sexual intercourse: results from 15 countries. Archives of Pediatrics & Adolescent Medicine 2008; 162:66-73.
  16. Mosher WD, Martinez GM, Chandra A et al. Use of contraception and use of family planning services in the United States: 1982-2002. Advance Data 2004; #350:1-36.
  17. Santelli JS, Morrow B, Anderson JE et al. Contraceptive use and pregnancy risk among U.S. high school students, 1991-2003. Perspectives on Sexual & Reproductive Health 2006; 38:106-111.
  18. Frost JJ, Darroch JE. Factors associated with contraceptive choice and inconsistent method use, United States, 2004. Perspectives on Sexual & Reproductive Health 2008; 40:94-104.
  19. Frost JJ, Singh S, Finer LB. Factors associated with contraceptive use and nonuse, United States, 2004. Perspectives on Sexual & Reproductive Health 2007; 39:90-99.
  20. Manlove J, Ryan S, Franzetta K. Contraceptive use and consistency in U.S. teenagers' most recent sexual relationships. Perspectives on Sexual & Reproductive Health 2004; 36:265-275.
  21. Kaiser Family Foundation & YM Magazine. National Survey of Teens: Teens Talk about Dating, Intimacy, and Their Sexual Experiences. Menlo Park, CA: The Foundation, 1998.
  22. Kaiser Family Foundation. Safer Sex, Condoms, and ‘The Pill’: A Series of National Surveys of Teens about Sex. Menlo Park, CA: The Foundation, 2000.
  23. Reddy DM, Fleming R, Swain C. Effect of mandatory parental notification on adolescent girls’ use of sexual health care services. JAMA 2002; 288:710-714.
  24. Savin-Williams RC. Verbal and physical abuse as stressors in the lives of lesbian, gay male, and bisexual youths: association with school problems, running away, prostitution, and suicide. Journal of Consulting & Clinical Psychology 1994; 62:261-269.
This publication is part of The Facts series.
 
Components of Promising Peer Led Sexual Health Programs Print

The prevalence of sexual risk behaviors among teenagers and young adults demands continued attention. Eighty five percent of the teenage pregnancies that occur each year are unintended.1 Each year, about three million teens contract a sexually transmitted disease (STD).2 While condom use rates are rising, only 54 percent of sexually active, in-school teens report consistent use.3 Finding effective ways to educate and motivate young people to avoid sexual risk behaviors is an ongoing challenge. Peer education*, with its grounding in social learning theory, draws upon the resources and existing social networks of young people to engage them in disease and pregnancy prevention among their peers. Peer education is experiencing a boom in popularity as programs are established in schools and universities, clinics, youth serving organizations, community based groups, and religious institutions.

Overwhelming amounts of anecdotal evidence vouch for the positive effects of peer education. Even more significantly, preliminary research indicates the promise and exciting possibilities of peer education. Despite the compelling stories and promising research, however, more scientific evaluation is needed. Specifically, more impact evaluation data must be collected and analyzed before peer education can be unequivocally touted as an effective prevention method.

While the goals of peer education programs may be similar, the philosophies and methods guiding such programs are often very different. Currently, centralized monitoring does not exist for the hundreds of peer education initiatives being implemented. Assistance in designing programs can be expensive and hard to find. As with any approach, certain programs will be more successful than others. This monograph presents a synthesis of elements of the most promising prevention strategies identified and used by peer led sexual health programs.4,5,6,7,8 By using the existing body of knowledge, program funders, planners, coordinators, and administrators can make the best use of scarce prevention dollars and maximize the positive benefits of programs for peer educators, their audiences, and the sponsoring organizations.

Designing the Program

  • Begin with a clearly defined target population. Consider age, gender, race/ethnicity, sexual orientation, socioeconomic factors, neighborhoods, whether the youth are in or out-of-school, etc. If data is available from local health departments, consider which groups of youth appear to have the highest rates of STDs or unintended pregnancy when targeting the intervention. Research other existing programs, and look for underserved members of the community.
  • Include members of the defined population from the beginning of the planning process. This means youth. Their participation will ensure that the program is a product of the community, helping create a feeling of ownership in the program and its goals rather than that it has been foisted upon the community by 'outsiders.' Youth must be invited not merely as tokens but as full participants. Young people should be present from the beginning, and their opinions and suggestions considered seriously. Meetings should be after school, accessible by public transportation or with transportation provided. Snacks and, perhaps, childcare can also help to keep young representatives participating.
  • Set a clearly defined program with realistic goals and objectives. One program cannot address all the issues facing teens, and a group of ten teenagers will not be able to reduce rates of STDs or pregnancy in a state, county, or town in six months. However, ten teenagers could present 12 workshops to 200 students over a period of 9 months and host a health fair that reaches 350 students or, over the period of 6 months, implement a curriculum in 10 health classes at the local high school, reaching 70 students. A time period and the number of people to be reached for each objective will help define the program and target population as well as ensure measurable goals and objectives.
  • Plan realistically for evaluation in the time line and budget. Whether a detailed process evaluation or a long-term impact evaluation, it must be planned from the beginning, or data gathered will be partial and inconclusive. The quantifiable objectives developed for the program will define the data to be gathered. Changes in knowledge will be measured by pre- and post-testing peer educators and participants. Process evaluation data may include numbers and characteristics of program activity participants, post-workshop satisfaction measures, focus groups data from workshop participants, and peer educator journal entries recording activities and referrals. Evaluation is a worthy investment. Demonstrating success encourages funders to support the program. Process evaluation allows ongoing assessment program strengths and weaknesses.
  • Find the right person or people to coordinate the program. Much of the success of a peer education program will rest on the program coordinator(s) who must understand youth and enjoy working with them. The coordinator must also be comfortable with the goals and objectives of the program. The coordinator should display a non-judgmental perspective while establishing high standards of expectation for program participants.

Implementing the Program

  • Recruit peer educators from a broad base of potential candidates. Consider opinion leaders within the defined population, but look also for those who strongly believe in the program's goals and objectives and want to help achieve them. Some of the most effective peer educators do not initially appear to be ideal candidates. Successful recruiters will search out young people, rather than simply expecting them to respond to a flyer or notice. Enlist teachers and other community and agency staff to make recommendations and to publicize the program among their youth.
  • Decide what incentives the program will provide for the peer educators. Some programs offer school credit or volunteer service hours. Local merchants may be willing to donate shirts, snacks, or discount coupons. Other programs build peer educator wages into their budgets. Programs that do not pay the peer educators may attract a limited or non-representative group of candidates.
  • Provide sufficient training for the peer educators. Skills development is as crucial as knowledge. Training empowers peer educators to recognize when to refer a peer to a professional. The training should model the supportive and interactive techniques that peer educators themselves will use. Successful programs will have ongoing training for the peer educators, times to practice existing skills and to develop new ones.
  • Select a curriculum to maximize interactive and experiential learning. Peer education works best when young people work with one another to learn new things or to develop new skills. Youth lectures are no more effective than adult lectures. Peer educators should be trained in facilitating and processing as well as in giving clear directions. Peer educators gain ownership of the program when they play a role in deciding which activities to use or in designing new ways to present the information.
  • Remember that research shows peer education to be most effective when part of a comprehensive initiative. Link peer educators with school nurses, 'youth friendly' local clinics, community agencies, and programs with similar goals. Ensure that peer educators know when and where to refer another young person. A local health professional from a teen clinic or other 'youth friendly' health provider may serve as an advisor to the peer educators and program staff and as a link to health services.
  • Monitor the peer educators' work. After the initial training, peer educators will need ongoing supervision of their work and training. Peer educators should keep a log of informal activities. Monitoring will highlight skills or knowledge that need strengthening. Feedback will also help the young people become more skillful and effective educators.
  • Provide ongoing encouragement and support. Peer educators work hard and their work is not always easy. Positive feedback and support will help keep trained youth involved, as will encouraging them to support each other and providing occasional incentives, such as pizza parties or small trips.
  • Expect attrition and have a formal structure for recruiting and training new peer educators. Youth have many competing interests; some may decide they do not enjoy being peer educators. Exit interviews will help gauge whether they are leaving for personal or programmatic reasons. Involving current peer educators in the recruitment and training of new peer educators will also empower them and help them develop new skills.
  • Provide opportunities for peer educators to give feedback about the program, its activities, and their own performance. The peer educators usually know what they need to become more effective and to enjoy their work more.
  • Finally, promote the program. Develop literature showcasing services and highlighting accomplishments. Positive stories from the peer educators and feedback from workshop participants will enliven databased reports. These materials will increase visibility and encourage potential funders to invest in to peer education program.

Written by Jane Norman, February 1998

Sources for Information, Technical Assistance, and Curricula

Guide to Implementing TAP: Teens for AIDS Prevention

A step-by-step guide to developing and implementing an HIV prevention peer education program in schools and communities. The guide is available online. For ordering information, contact 2000 M Street NW, Suite 750, Washington, DC 20036; or call 202.419.3420.

Peer Education… a Little Help from Your Friends: A How-To Manual

Developed by Planned Parenthood Centers of Western Michigan, this 40-hour comprehensive health training provides a multitude of original as well as adapted ideas, activities, and materials. For ordering information, contact Planned Parenthood Centers of West Michigan, 425 Cherry SE, Grand Rapids, MI 49503; or call 616/774-7005.

Healthy Oakland Teens

A school-based, peer-led AIDS prevention program for junior high school students. Evaluation showed that students who received AIDS prevention counseling from their peers were significantly less likely to engage in potentially risky vaginal intercourse than students who were not involved in the peer-led counseling. The curriculum is available via the Center for AIDS Prevention Studies Web site, along with a Knowledge, Attitudes, Behavior, Belief questionnaire for use with teens and pre-teens. URL: http://www.caps.ucsf.edu/capsweb/hotindex.html. Contact Center for AIDS Prevention Studies, 74 New Montgomery, Suite 600, San Francisco, CA 94105; or call 415/597-9100.

Peer Facilitator Quarterly

The official publication of the National Peer Helpers Association. For subscription information, contact the National Peer Helpers Association, PO Box 10627, Gladstone, MO 64188-0627; or call 877/314-7337.

PeerHelp: A New LISTSERV for Peer Helper Programs and Training

Created to help those interested in peer helping share information such as ideas, techniques, and resources this requires access to electronic mail. For more information or to subscribe, contact Dr. Russell Sabella, School of Education, University of Louisville, Louisville, KY 40292: or call 502/852-0625; E-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

References

* A note about terminology: although many people use the terms peer helping, peer tutoring, peer counseling, and peer education interchangeably, they represent different concepts and different goals. For the purposes of this document, peer education refers to sexual health workshops given by and for adolescents.

  1. Trussell J. Koenig J. Stewart F. et al. Medical care cost savings from adolescent contraceptive use. Fam Plann Perspect 1997:29:248.
  2. Alan Guttmacher Institute. Sex and America's Teenagers. New York, NY: The Institute, 1994.
  3. Kann L, Warren CW, Harris WA, et al. Youth Risk Behavior Surveillance, United States. 1995. MMWR CDC Surveillance Summaries 1996:45(SS-4): 1 -84.
  4. Holtgrave D, Qualls N. Curran J. et al. An overview of the effectiveness and efficiency of HIV prevention programs. Public Health Reports 1995:110:134-146.
  5. Janz N. Zimmerman M, Wren P. Evaluation of 37 AIDS prevention projects: successful approaches and barriers to program effectiveness. Health Educ Q 1996:23:80-97.
  6. Kirby D. No Easy Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy, 1997.
  7. HIV Education and Prevention Working Group. What are the Characteristics of HIV Education and Prevention Programs that 'Work' and 'Do Not Work'? HIV Education Prevention Working Group Meeting August 7, 1991. San Francisco, CA: Office of AIDS, California Dept. of Health Services, 1991.
  8. Davis L. Components of Promising Teen Pregnancy Prevention Programs. [Issues at a Glance] Washington, DC: Advocates for Youth, 1996.
This publication is part of Issues at a Glance series.
 
La prevención del VIH/ETS y los hombres jóvenes que tienen relaciones sexuales con hombres Print

También disponible en inglés [HTML].

La prevención del VIH y otras enfermedades de transmisión sexual (ETS) que está dirigida a hombres homosexuales raramente responde a las necesidades de los hombres jóvenes que tienen relaciones sexuales con hombres (siglas en inglés YMSM*). Algunos YMSM no prestan atención a los mensajes dirigidos a homosexuales porque no se identifican como tales. Muchos YMSM temen el estigma social y la violencia—intensificados algunas veces por la cultura y la religión—dirigidos a quienes se identifican como tales. Otros se identifican como bisexuales y no internalizan los mensajes dirigidos a los homosexuales. Algunos adolescentes varones, inseguros de su orientación sexual, ven las relaciones sexuales con personas del mismo sexo como experimentales y pasajeras. Debido a que rara vez se identifican como homosexuales, estos YMSM pueden no reconocer los comportamientos inseguros que los ponen en riesgo de infección por el VIH/ETS.1,2

Por otra parte, los programas de prevención del VIH/ETS dirigidos a adolescentes suelen excluir a los YMSM. La mayoría de los esfuerzos de prevención llevados a cabo en las escuelas intentan convencer a todos los adolescentes de que son susceptibles al VIH/ETS. De esta manera, estos programas inadvertidamente excluyen los mensajes dirigidos específicamente a los YMSM. Los currículos escolares que contienen mensajes como "el SIDA no es una enfermedad de homosexuales" pueden llevar a que algunos YMSM que se identifican como tales piensen que no están en riesgo. Algunos programas escolares deliberadamente ignoran la existencia de jóvenes que se identifican como homosexuales y de YMSM que no se identifican como homosexuales. Estas deficiencias en los mensajes de prevención subestiman la necesidad de programas que se enfoquen en YMSM, al margen de la autoidentificación, y que contengan mensajes que reconozcan y reflejen la diversidad entre los YMSM.

Muchos YMSM manifestan comportamientos que los ponen en riesgo de infección con VIH/ETS

Según varios estudios, entre el 27% y el 48% de YMSM habían practicado sexo anal sin protección durante los previos seis meses.3,4,5 En un estudio, el 63% de los YMSM habían corrido "riesgos extremos" de previa exposición al VIH por sexo anal sin protección y/o el uso de drogas inyectables.6 Al igual que otros adolescentes, muchos YMSM pasan por una etapa de experimentación sexual caracterizada por múltiples compañeros sexuales. El riesgo de contraer el VIH/ETS aumenta con el número de compañeros sexuales. En un estudio, el 44% de los YMSM dijieron que habían tenido por lo menos 10 compañeros sexuales.5 Algunos YMSM exploran sus sentimientos o tratan de esconder o cambiar su orientación sexual a través de tener sexo con mujeres jóvenes. Un estudio indicó que los YMSM que tienen sexo con mujeres son hasta dos veces más propensos a tener sexo sin protección con sus compañeros sexuales masculinos que los que sólo tienen sexo con hombres.7

La comunicación asertiva con los compañeros acerca del sexo más seguro es muchas veces difícil para los YMSM que no tienen modelos a imitar o una educación sexual adecuada, pero que están explorando relaciones íntimas con hombres.6 Como los adolescentes están 10 a 17 veces más predispuestos a usar condones si se sienten cómodos hablando del SIDA con sus compañeros, los YMSM que no tienen apoyo y destrezas están en riesgo de tener sexo inseguro.8 Un estudio indicó que los YMSM discutieron el uso de condones con menos de un tercio de sus últimos tres compañeros y su status respecto al VIH con aún menos compañeros.6 El no conocer bien al compañero también puede entorpecer la comunicación acerca del sexo más seguro. En efecto, un estudio indicó que, después del asalto sexual, los encuentros sexuales en lugares anónimos constituyen el factor que mejor predice el sexo sin protección entre los YMSM.7 Por otro lado, algunos YMSM creen que las relaciones estables los protegerán del VIH y usan condones con menos frecuencia en estas relaciones.3,6,9

Por falta de apoyo social en una sociedad homofóbica, muchos YMSM empiezan usar alcohol y drogas. Comparados con los jóvenes heterosexuales, los jóvenes homosexuales, lesbianas, bisexuales y transgénero están dos veces más predispuestos a usar alcohol, tres veces más predispuestos a usar marihuana y a mostrar síntomas serios del abuso de drogas, y ocho veces más predispuestos a usar cocaína.9,10 El uso de alcohol o drogas hace que la negociación del sexo más seguro sea más difícil y aumenta la probabilidad de tener sexo sin protección.11,12

Es más factible que los comportamientos sexuales de riesgo resulten en la transmisión del VIH en poblaciones donde ya existe un alto porcentaje de infección.13 Un estudio de YMSM en seis condados urbanos indicó que entre el 5% y el 9% de los YMSM estaban infectados con el VIH.4 A nivel nacional, la categoría principal de exposición al VIH para adolescentes varones de 13 a 19 años es la del sexo con personas del mismo sexo, constituyendo el 46% de los casos cumulativos de VIH y el 34% de los casos cumulativos de SIDA. Entre jóvenes de 20 a 24 años la proporción de casos aumenta al 55 y al 63%, respectivamente.14 En una encuesta entre YMSM que tomaron la prueba para detectar el VIH, 70% de los que resultaron VIH-positivos no sabían que estaban infectados.3

La homofobia social pone a los YMSM en mayor riesgo

Hasta un 80% de los jóvenes homosexuales, lesbianas, bisexuales y transgénero reportan sentirse aislados socialmente y emocionalmente.15 Cambios físicos y psicológicos ponen a muchos adolescentes en riesgo de infección por VIH/ETS, pero los jóvenes con dudas acerca de su orientación sexual enfrentan un riesgo más alto porque ellos "de manera particular…crecen sintiéndose diferentes y solos."16 Usualmente a los jóvenes homosexuales, lesbianas, bisexuales, y transgénero les falta apoyo de sus pares y muchas veces enfrentan abuso verbal y físico debido a su orientación sexual. Una cuarta parte de YMSM se ve forzada a abandonar su hogar a causa de su orientación sexual; hasta la mitad de estos jóvenes recurren a la prostitución para mantenerse—aumentando significativamente su riesgo de tener sexo sin protección.17 Los YMSM suelen no tener modelos positivos debido a que muchos adultos homosexuales tienen miedo de revelar su orientación sexual.

Como otros adolescentes, los YMSM necesitan relaciones íntimas; pero muchas veces tienen que obtenerlas sin apoyo o aprobación social. Al esconder sus identidades y deseos, muchos YMSM tienen una necesidad de afecto que sobrepasa cualquier otra preocupación, incluyendo su salud. La hostilidad social hacia las relaciones íntimas entre personas del mismo sexo puede hacer que para los YMSM éstas sean "la única forma de…escapar el aislamiento social y emocional."1

Los YMSM pueden internalizar la homofobia, y algunos llegan a creer los mitos de que los hombres homosexuales no pueden mantener relaciones y que están destinados a morir del SIDA.18 Muchas veces la homofobia internalizada resulta en una autoestima baja y depresión. De hecho, los YMSM son siete veces más predispuestos a intentar suicidio que los jóvenes heterosexuales.19 Mientras los jóvenes heterosexuales visualizan su futuro hasta los 50 años, muchos adolescentes homosexuales no se imaginan sus vidas más allá de los 33 años.19 Muchos YMSM creen que no hay nada bueno en llegar a ser un adulto homosexual. Un YMSM respondió, "muchos jóvenes homosexuales [creen] que el VIH…significa que no voy a estar aquí en 10 a 15 años, y yo no quiero estar aquí [en ese momento]."19

Muchos hombres homosexuales de mayor edad conocieron el SIDA a través de la muerte de amigos, y su sensación de pérdida personal creó un cambio sin precedentes en los comportamientos de riesgo dentro de la comunidad gay adulta.13 Aunque los YMSM que consistentemente practican sexo anal más seguro se perciben como susceptibles al VIH,20 pocos han presenciado las consecuencias fatales del sexo inseguro, y muchos no se sienten particularmente susceptibles al VIH. Aunque el apoyo de los pares con respecto al sexo más seguro es una de las mejores maneras de fomentar el uso de condones, muchas veces los YMSM no tienen este apoyo.3,21 Algunos YMSM pueden asociar el VIH con homosexuales mayores y asumir que sus compañeros jóvenes, aparentemente saludables, son VIH-negativos. Al faltarles modelos que sean VIH-negativos, algunos YMSM consideran la infección con VIH como un ritual de paso hacia la vida de la comunidad homosexual adulta.16 El considerarse invulnerables es una característica de los jóvenes pero es especialmente un problema para los YMSM, teniendo en cuenta su riesgo de contraer el VIH y sus tasas más bajas de sexo más seguro, comparadas con las de los homosexuales de mayor edad.22

El racismo pone a los YMSM de color en más alto riesgo

Los YMSM de color enfrentan dos tipos de discriminación—racismo y homofobia—que pueden aumentar su riesgo de contraer el VIH. En efecto, los YMSM de color tienen tasas más altas de VIH/SIDA que los YMSM blancos. En un estudio, el 7.8% de latinos, el 12.5% de asiáticos y el 14.3% de afroamericanos estaban infectados con el VIH—mucho más que el 3.9% de los YMSM blancos.5 Algunos YMSM de color pueden estar más predispuestos a no tener una noción adecuada de su riesgo de contraer el VIH que los YMSM blancos.13,24 En un estudio, el 64.3% de YMSM indo-americanos dijeron que habían practicado sexo anal sin protección, siendo esto más de lo que fue reportado por cualquier otro grupo étnico-racial.5

Estas diferencias suelen deberse a la falta de intervenciones cultural y lingüísticamente apropiadas para las comunidades de color. Debido a las barreras creadas por la homofobia y el racismo, las intervenciones para los YMSM de color tendrían que enfocarse tanto en estrategias comunitarias que reflejen los matices culturales como en cambios de comportamiento individual.23,24 Por ejemplo, un estudio sugiere que las intervenciónes deben concentrarse en aumentar la capacidad colectiva de los YMSM afroamericanos para enfrentar el VIH y desarrollar la tolerancia hacia los YMSM dentro de las comunidades afroamericanas.24

Los programas efectivos deben desarrollar destrezas y afirmar el valor de los YMSM

La falta de información, información errónea y la homofobia son comunes en la educación sexual que se imparte en las escuelas.25 Algunos educadores deciden o son obligados a enseñar que el comportamiento homosexual es inaceptable. Muchos asumen que todos los estudiantes son heterosexuales y enseñan la reducción de riesgo solamente en términos de contacto heterosexual o enseñan abstinencia sexual hasta el matrimonio—conceptos que frecuentemente son poco pertinentes para los YMSM. El no proveer educación para reducir los riesgos entre los YMSM implica que ellos no existen y se les niega "…instrucción acerca de cómo manejar sus vidas sexuales responsablemente."9,13

El uso de información homofóbica en la educación para la prevención del VIH/ETS es particularmente inquietante porque los esfuerzos de prevención que son realistos y balanceados pueden realizar cambios de comportamiento. Después de una intervención dirigida a los YMSM, el sexo anal sin protección disminuyó un 60% y el uso de condones para sexo anal aumentó un 50%.26

A pesar de que los YMSM suelen demostrar un buen conocimiento acerca de la transmisión del VIH, demasiados participan en actividades de alto riesgo.2,6 Esto evidencia que el conocimiento de por sí no produce cambios de comportamiento. Para ser efectiva, la prevención del VIH/ETS debe considerar los factores sociales y de desarrollo individual que conducen a los comportamientos de riesgo y desarrollar destrezas que traduzcan el conocimiento en cambios de comportamiento. Los siguientes componentes críticos para la prevención del VIH/ETS han sido obtenidos a través de estudios.

  • Adaptar los programas para incluir a los YMSM. Los programas desarrollados para todos los jóvenes deben abordar el tema de la orientación sexual e incluir discusiones acerca de sexo anal así como formas de reducir los riesgos de transmisión del VIH/ETS. Los programas deben incluir términos como "pareja sexual" y "comportamiento sexual con personas del mismo sexo." Además, los YMSM necesitan intervenciones diseñadas especialmente para ellos.
  • Involucrar a la juventud. Los grupos de apoyo entre pares proveen oportunidades—al margen de los encuentros sexuales—en que los YMSM pueden compartir sus emociones y experiencias, aliviar sus sentimientos de soledad y desarrollar sistemas de apoyo. Involucrar a los YMSM en el diseño e implementación de programas reduce sus comportamientos de riesgo y fomenta su espíritu de autodeterminación y autoestima.
  • Fomentar el sentido de valor propio. La prevención debe afirmar el valor de los YMSM y crear un contexto que fomente los comportamientos sexuales responsables. Las sesiones de consejería individual son muy efectivas al inicio de estas intervenciones.
  • Satisfacer las necesidades de los jóvenes. Poner atención en las necesidades identificadas por los YMSM, no por los adultos. Esto puede incluir: patrocinar grupos de apoyo, desarrollar destrezas para las relaciones de pareja, y proveerles de mentores u otros modelos de comportamiento.
  • Enseñar destrezas. Los programas deben enseñar destrezas. Las habilidades de usar condones, negociar sexo más seguro, construir relaciones, comunicarse con sus compañeros regulares o casuales, tomar decisiones y decir "no", fortalecen a los adolescentes para la toma decisiones saludables.27
  • Proveer apoyo constante. Como es difícil mantener los cambios de comportamiento, las poblaciones en alto riesgo requieren apoyo continuo y refuerzo. Para prevenir una recaída en comportamientos inseguros, los programas de prevención deben tomar en consideración que las necesidades de los YMSM cambian a medida que se van haciendo adultos.
  • Empezar temprano. Como el indicador más importante de los comportamientos de riesgo para la infección con VIH/ETS entre los jóvenes es su historia sexual, la prevención es más efectiva cuando se empieza antes de que comiencen a ser sexualmente activos.28,29 La prevención del VIH/ETS, que busca avanzar de acuerdo al desarrollo de los jóvenes, debe comenzar en la adolescencia temprana y apoyar tanto un comportamiento sexual responsable como conceptos saludables acerca de uno mismo. La educación sexual que se imparte en las escuelas puede reducir eficazmente los comportamientos sexuales de riesgo, sin aumentar la actividad sexual.
  • Crear programas dirigidos específicamente para los YMSM de color. Los estudios indican que los programas tienen que tomar en consideración los factores individuales, comunitarios y culturales que son pertinentes a los YMSM. Los programas deben abordar el tema del racismo en la comunidad homosexual blanca y, a la vez, apoyar a los YMSM de color a manejar sus decisiones acerca de su sexualidad, su identidad homosexual, su cultura y raza/etnia. Los YMSM necesitan un ambiente seguro para poder compartir sus experiencias.
  • Tomar en consideración las necesidades de los grupos marginados tales como los jóvenes sin hogar y los jóvenes abusados sexualmente. Los programas deben alcanzar a los jóvenes sin hogar, especialmente a los que están envueltos en prostitución, ya que es muy probable que no estén en la escuela. Los programas de alcance para educar a los YMSM sin hogar deben atender primero sus necesidades de alimentación, vestimiento y refugio. Sólo después de satisfacer estas necesidades se puede llamar su atención sobre asuntos relacionados con su salud sexual.

Pedro Zamora, quien murió en 1994 a la edad de 22 años, dijo acerca de las necesidades de los YMSM, "Yo necesitaba mensajes positivos acerca de mi sexualidad. Necesitaba saber de condones, cómo usarlos correctamente y dónde comprarlos. Necesitaba saber que uno puede ser sexual sin tener sexo. Necesitaba saber cómo decir 'No quiero tener sexo, sólo quiero que alguien me abrace.'"30

* En este Vistazo a un Tema, el término YMSM define a una categoría de hombres menores de 23 años que tienen sexo con otros hombres. Esta clasificación incluye a todos aquellos que se identifican a sí mismos como gays, homosexuales, bisexuales, heterosexuales, transgénero, así como a los que tienen dudas acerca de su identidad sexual.

Escrito por Deborah Roseman y Kent Klindera
Traducido y editado por Larry Villegas, Octubre de 2000

Bibliografía

  1. Martin AD, Hetrick ES. Designing an AIDS risk reduction program for gay teenagers: problems and proposed solutions. In: Ostrow DB, ed. Biobehavioral Approaches to the Control of AIDS. New York: Irvington, 1987.
  2. Sussman T. Duffy M. Are we forgetting about gay male adolescents in AIDS-related research and prevention? Youth & Society 1996; 27: 379-393.
  3. Lemp GF, Hirozawa AM, Givertz D, et al. Seroprevalence of HIV and risk behaviors among young homosexual and bisexual men. JAMA 1994; 272:449-454.
  4. Valleroy LA, MacKellar D, Janssen R. et al. HIV and Risk Behavior Prevalence among Young Men Who Have Sex with Men Sampled in Six Urban Counties in the USA. Presented at XI International Conference on AIDS, Vancouver, Canada, 1996.
  5. HIV Epidemiology Program, Los Angeles County Dept. of Health. Young Men's Survey: Los Angeles, Aug. 1994- Jan. 1996. Presented to Los-Angeles County Adolescent HIV Consortium, Los Angeles, CA, 1996.
  6. Remafedi G. Predictors of unprotected intercourse among gay and bisexual youth: knowledge, beliefs, and behavior. Pediatrics 1994; 94:163-68.
  7. Smith C, duBay K, Langenbahn S. Young men who have sex with men: findings from questionnaires, focus groups and interviews in Massachusetts. [s.l.]: Abt Associates, 1996.
  8. Shoop DM, Davidson PM. AIDS and adolescents: the relation of parent and partner communication to adolescent condom use. JAdolesc 1994; 17:137-148.
  9. American Health Consultants. Program dedicated to gay adolescents fills support gap. AIDS Alert 1993; 8:188-189.
  10. Telljohann SK, Price JH, Poureslami M, et al. Teaching about sexual orientation by secondary health teachers. JSch Health 1995; 65:18-22.
  11. Valleroy L. The Prevalence and Predictors of Unprotected Receptive Anal Intercourse for 15- to 22-year-old Men Who Have Sex with Men in Seven Urban Areas, U.S.A. Presented at the XII International Conference on AIDS, Geneva, Switzerland, 1998.
  12. Hays RB. What Are Young Gay Men's HIV Prevention Needs? San Francisco: Center for AIDS Prevention Studies, University of California, 1996.
  13. Cranston K. HIV education for gay, lesbian, and bisexual youth: personal risk, personal power, and the community of conscience. In: Coming Out of the Classroom Closet. Binghamton, NY: Haworth, 1992.
  14. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report 1997; 9(2):1-43.
  15. Hetrick-Martin Institute. Lesbian, Gay, and Bisexual Youth. [Fact File] New York: The Institute, 1992.
  16. Green J. Flirting with suicide. The New York Times Magazine 1996; Sept. 15: 39-44+.
  17. Macieira M, Messina S. The invisible minority: lesbian and gay youth. PSAYNetwork 1994; 2(1):7-8.
  18. Grossman A. Homophobia: a cofactor of HIV disease in gay and lesbian youth. JANAC 1994; 5(1):39-40.
  19. American Health Consultants. Peer education, reduction of risk appeal to gay teens. AIDS Alert 1995;10:131-132.
  20. Rotheram-Borus MJ, Reid H. Rosario M, et al. Determinants of safer sex patterns among gay/bisexual male adolescents. JAdolesc 1995; 18-3-15.
  21. American Health Consultants. New generation of gay men not heeding safe-sex warnings. AlDS Alert 1994; 9:151- 153.
  22. US Conference of Mayors. Safer sex relapse: a contemporary challenge. AIDS Information Exch 1994; 11(4):1-8.
  23. Beeker C, Kraft JM, Peterson JL, et al. Influences on sexual risk behavior in young African American men who have sex with men. J Gay & Lesbian Medical Assoc 1998; 2:59-67.
  24. Choi KH, Yap GA, Kumekawa E. HIV prevention among Asian and Pacific Islander men who have sex with men: a critical review of theoretical models and directions for future research. AIDS Educ Prev 1998; 10 (Suppl A):19-30.
  25. Remafedi G. The impact of training on school professionals' knowledge, beliefs, and behaviors regarding HIV/AIDS and adolescent homosexuality. JSch Health 1993; 63:153-157.
  26. Remafedi G. Cognitive and behavioral adaptations to HIV/AIDS among gay and bisexual adolescents. J Adolesc Health 1994; 15:142-148.
  27. National Commission on AIDS. Preventing HIV/AIDS in adolescents. JSch Health 1994; 64:39-51.
  28. Rotheram-Borus MJ, Reid H. Rosario M. Factors mediating changes in sexual HIV risk behaviors among gay and bisexual male adolescents. Am J Public Health 1994;84:1938-1946.
  29. Stryker J. Coates TJ, DeCarlo P. et al. Prevention of HIV infection: looking back, looking ahead. JAMA 1995; 273:1143-1148.
  30. Coates T, DeCarlo P. For Pedro: a Rededication to Helping Young Gay Men Stay Safe. San Francisco: Center for AIDS Prevention Studies, University of California, 1996.

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Parent-Child Communication Basics Print

An Education Program to Enhance Parent-Child Communication

Research indicates that strong family relationships can help children develop self-esteem, resist peer pressure, and act responsibly when making decisions about drugs, violence, and sexual intercourse. Effective parent-child communication is a cornerstone of strong and healthy families. In the era of HIV/AIDS, parents must learn ways to communicate more effectively with their young people. How and what they communicate about body image, peer pressure, puberty, reproduction, sexuality, love, and intimacy can make a significant difference in the health and well-being of their children.

This notebook contains all of the materials needed to conduct a 75-minute, introductory seminar on general parent-child communication.

Table of Contents

 

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